scholarly journals Metastasizing pleomorphic adenoma presenting as an asymptomatic kidney tumor twenty-nine years after parotidectomy – urological viewpoint and overview of the literature to date

Rare Tumors ◽  
2009 ◽  
Vol 1 (2) ◽  
pp. 167-168
Author(s):  
Jan Ebbing ◽  
Carolin Blind ◽  
Harald Stein ◽  
Kurt Miller ◽  
Christoph Loddenkemper
Keyword(s):  
Therapeutic Strategy ◽  
Systemic Disease ◽  
Rare Event ◽  
Adequate Information ◽  
First Choice ◽  
Pleomorphic Adenomas ◽  
Choice Of Treatment ◽  
Tumor Entity ◽  
Mixed Tumors ◽  
Overall Mortality

Pleomorphic adenomas (benign mixed tumors) are the most common tumors of glandular origin in the head and neck and are one of the few benign neoplasms that can undergo malignant transformation. 1 Mixed tumors that are seemingly benign at the microscopic level but metastasize have been termed metastasizing mixed tumors (MZMTs). The entity of metastasizing benign mixed tumors has been reported since the early 1940s, with up to approximately 50 cases described in the literature to date. Despite their bland morphologic appearance, MZMTs have been associated with an overall mortality rate of about 20–40%. We report the case of a MZMT of the kidney almost 30 years after lateral parotidectomy owing to the same tumor entity. For benign mixed tumors, we are unaware of more than two other cases of metastasis to the kidney that have been published, whereas metastases to the bone, lung, and lymph nodes are more common. Parotidectomy is widely accepted as the first choice of treatment, 13 but once metastases have occurred the therapeutic strategy is uncertain with surgery being the only curative option in cases with resectable disease. This case report provides information about the rare event of metastatic disease to the kidney and points out therapeutic strategies. However, in view of the general lack of adequate information in the literature, the best therapy for systemic disease still remains unresolved.

scholarly journals Clinical Course of Laryngeal Granuloma Without Surgical Treatment

2001 ◽  
Vol 7 (3-4) ◽  
pp. 129-133 ◽  
Author(s):  
Satoshi Horiguchi ◽  
Mamoru Suzuki ◽  
Hideo Takagi ◽  
Toshiro Yamanishi ◽  
Kazuhiro Nakamura
Keyword(s):  
Surgical Treatment ◽  
Therapeutic Strategy ◽  
Clinical Course ◽  
Surgical Removal ◽  
Vocal Hygiene ◽  
First Choice ◽  
Choice Of Treatment ◽  
Laryngeal Granuloma

Laryngeal granuloma is a rather common pathological entity, but its therapeutic strategy is still controversial. In general, therapeutic strategy consists of medications such as steroids or tranilast, in addition to vocal hygiene and surgery. Surgical removal is most commonly performed. However, it has recently been reported that recurrence after surgery is high.We successfully treated 19 of 20 cases of laryngeal granuloma without surgical removal. It took 28–328 days for the granulomas to disappear. Therefore conservative treatments should be the first choice of treatment.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

Surgery of ulcus cruris venosum

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 156-162 ◽  
Author(s):  
C. Schwahn-Schreiber
Keyword(s):  
Subcutaneous Tissue ◽  
Ulcus Cruris ◽  
Healing Time ◽  
Ulcus Cruris Venosum ◽  
Venous Stasis ◽  
Morphological Alterations ◽  
First Choice ◽  
Choice Of Treatment ◽  
Chronic Compartment Syndrome ◽  
Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

scholarly journals Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mareike Franke ◽  
Jasper Franke ◽  
Christian Saager ◽  
Sven Barthel ◽  
Randolf Riemann ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Neurological Complications ◽  
Surgical Approaches ◽  
Success Rates ◽  
Artery Ligation ◽  
Retrospective Data Analysis ◽  
First Choice ◽  
Surgical Methods ◽  
Choice Of Treatment ◽  
Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

scholarly journals Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Soichiro Obata ◽  
Michi Kasai ◽  
Junko Kasai ◽  
Kazuo Seki ◽  
Zenjiro Sekikawa ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Uterine Artery Embolization ◽  
Therapeutic Strategy ◽  
Arterial Embolization ◽  
Artery Embolization ◽  
Intravascular Coagulation ◽  
First Choice ◽  
Uterine Arterial Embolization ◽  
Effective Therapeutic Strategy

Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P=1.000) or ISTH DIC score (54.5% versus 76.5%, P=0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.

scholarly journals Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 203-207 ◽  
Author(s):  
S. Ushikoshi ◽  
K. Hida ◽  
Y. Kikuchi ◽  
Y. Iwasaki ◽  
K. Miyasaka ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Radical Excision ◽  
Arteriovenous Fistulas ◽  
First Choice ◽  
Choice Of Treatment ◽  
Technical Complication ◽  
Surgical Manipulation ◽  
Residual Lesions

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy. Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy. Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years. In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.

scholarly journals Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1058
Author(s):  
Chul-Hyun Cho ◽  
Du-Han Kim ◽  
Sang Soo Na ◽  
Byung-Chan Choi ◽  
Beom-Soo Kim
Keyword(s):  
Systematic Review ◽  
Positive Outcome ◽  
Olecranon Fracture ◽  
Dash Score ◽  
Eligibility Criteria ◽  
First Choice ◽  
Retrospective Clinical Study ◽  
Flexion Extension ◽  
Choice Of Treatment ◽  
Fracture Dislocations

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion–extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

scholarly journals How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

2018 ◽  
Vol 1 (1) ◽  
pp. e000002
Author(s):  
Jianghua Zhan ◽  
Yajun Chen ◽  
Kenneth K Y Wong
Keyword(s):  
Liver Transplantation ◽  
Survival Rate ◽  
Early Diagnosis ◽  
Biliary Atresia ◽  
Further Education ◽  
Monitoring Methods ◽  
Kasai Operation ◽  
First Choice ◽  
Choice Of Treatment ◽  
Hepatobiliary Diseases

BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

scholarly journals Pediatric Thoraco-Lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 158-162
Author(s):  
Y. Niimi ◽  
A. Berenstein ◽  
P.M. Fernandez ◽  
J.L. Brisman ◽  
J.K. Song
Keyword(s):  
Venous Drainage ◽  
Imaging Features ◽  
Av Fistula ◽  
Arteriovenous Fistulas ◽  
Thoracic Level ◽  
Segmental Nerve ◽  
First Choice ◽  
Diagnostic Angiography ◽  
Choice Of Treatment ◽  
Detachable Coils

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve. Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.

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